Tracy9
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I got my son's WB test results today; he had no bands on IGM (they seem to have only tested for three bands: 23, 39, and 41) and one band on IGG, and it was 28.
I read all the links on Western Blot results, and I have found completely contradictory information there.
Dr. Jones says "Band 28 is non specific and cross reacting" and Dr. Donta say it is specific and NOT cross reacting.
What should I think? Since this is his only band, I don't know what to do. He does not have an LLMD; I was waiting for these test results to see if he should see one.
13 years Lyme & Co.; Small Fiber Neuropathy; Myasthenia Gravis, Adrenal Insufficiency. On chemo for 2 1/2 years as experimental treatment for MG. Posts: 4480 | From Northeastern Connecticut | Registered: Jun 2005
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Was the western blot test done by Igenex? If not, you might want to redo the test, since Igenex tests on more bands.
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Where did you test him? Why you think he only was tested for 3 bands and not ALL of them.
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Tracy9
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The test was done by Quest. I have no idea why they only tested 3 bands on the IGM. The IGG had more.
Anyone have any insight on band 28? I will probably continue to try and get him into Dr. Jones anyway; but finances are extremely tight right now. I just don't know what to think.
13 years Lyme & Co.; Small Fiber Neuropathy; Myasthenia Gravis, Adrenal Insufficiency. On chemo for 2 1/2 years as experimental treatment for MG. Posts: 4480 | From Northeastern Connecticut | Registered: Jun 2005
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timaca
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tracy~ what are your son's symptoms? Timaca
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Tracy9
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Kind of vague; he's 12; but most alarming was that he was just on Bactrim for a sinus infection and developed bilateral hip pain at about day 4 or 5. He also complained about back pain. Then that went away but he awoke one day with a stiff neck and severe neck pain.
Other than that, which screamed "herx" to me, he has severe ADHD, and over the last year or so has been very fatigued, dark circles under his eyes, complains here and there of joint pain....ankles, knees, elbows, comes and goes. He is not a complainer, he rarely tells me when something is wrong.
May be totally unrelated, but he has bad asthma, is always sick with sinus infections, colds, had 22 ear infections before age 2, ear tubes 9 times, had mastoiditis twice, in different ears, had obstructive sleep apnea (tonsils and adenoids removed at 2), often gets diarrhea and vomits fairly often.
Now I have no idea if any of those symptoms have anything to do with Lyme....and his bloodwork also revealed he has had mono in the past, but he is just a sickly, though hyperactive, child.
This past year we have worried because of the fatigue, dark circles, and complaints of joint pains here and there. They will last about a week or so when he gets them.
Mom, Dad, and older brother all have chronic lyme. I worry he got it from me congenitally.
13 years Lyme & Co.; Small Fiber Neuropathy; Myasthenia Gravis, Adrenal Insufficiency. On chemo for 2 1/2 years as experimental treatment for MG. Posts: 4480 | From Northeastern Connecticut | Registered: Jun 2005
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Tracy9
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Oh, he is also very small for his age, underweight, doesn't eat much at all.
He also has always had terrible insomnia, a real night owl.
AND he has terrible teeth, lots of cavities.
Again, all random things....could be totally unrelated, but I thought I'd put it all out there.
13 years Lyme & Co.; Small Fiber Neuropathy; Myasthenia Gravis, Adrenal Insufficiency. On chemo for 2 1/2 years as experimental treatment for MG. Posts: 4480 | From Northeastern Connecticut | Registered: Jun 2005
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FDA Public Health Advisory: Assays for Antibodies to Borrelia burgdorferi; Limitations, Use, and Interpretation for Supporting a Clinical Diagnosis of Lyme Disease Assays for anti-Bb should be used only to support a clinical diagnosis of Lyme disease. FDA
CDC says same thing these tests are finite. They should only be used to help not hinder lyme diagnoses it should be a Clinical judgement made by a LLMD .
That said read this. Explaining Borreliosis (Lyme) Western Blot Tests There is no universal agreement on what defines a positive Western blot. Good laboratories use different criteria to interpret borreliosis blots. At the 1999 international borreliosis and tick-borne infection conference, Sam Donta, M.D. lectured. Dr. Donta is a full professor of Infectious Disease at Boston University School of Medicine. He said that if a patient has just one borreliosis-associated antibody on their Western blot, you may assume they have borreliosis. Richard Horowitz, M.D. said the same thing in his lecture, at that same conference. Research I presented in 1998 involving over 400 borreliosis patients, showed an 87% response rate to antibiotics. This was if they had one borreliosis-associated antibody on their blot. So if there is enough suspicion that Lyme borreliosis is the cause of a patient's symptoms, so much so that a Western blot is ordered, then if only one borreliosis-associated antibody is found, it is significant! Medical literature is replete with statements about false positive test results for Lyme borreliosis. Since 1988, I have diagnosed and treated well over 600 borreliosis patients. Only 2 of those patients with a positive borreliosis test did not respond to antibiotics. This is a 99% success rate! So in the trenches of day-to-day medical practice, false positive borreliosis tests are not an issue. In retrospect, those 2 patients that did not respond to antibiotics may have also had babesiosis. In my practice, many borreliosis patients also have babesiosis, another tick-borne infection that causes the same symptoms as Lyme borreliosis. Babesiosis is caused by a protozoa, which is a different germ type than a bacteria, virus, fungus or yeast. The placebo effect would not explain a 99% response rate. Those borreliosis associated antibodies should not be there, in patients with symptoms. A placebo is like a sugar pill, that has no effect. A placebo effect occurs because patients believe in the pill they are taking, even though it is a sugar pill. The human mind causes the response. Placebo effects should more likely be about 20-30%, not a 99% response rate. False negative test results are the real problem in diagnosing borreliosis. Research has shown that you have to do the right test (the Western blot), done at the right laboratory (one that specializes in testing borreliosis), and done the correct way (shipped express delivery early in the week). The right test to screen for borreliosis is the Western blot. Research I presented in Bologna, Italy in 1994 at the international borreliosis conference showed this. Other screening tests, such as the IFA, EIA, ELISA, and PCR DNA probe were often negative when the Western Blot was positive! Other doctors like myself who diagnose and treat a lot of borreliosis patients, go straight to the Western blot as their screening test. Medical articles abound stating that it is best to do a screening test, such as an ELISA, and if it is positive, then confirm it with a Western blot. But the ELISA is often negative when the Western blot is positive so, the right test is the Western blot. *** It lets you see exactly which antibodies are present. The "right laboratory" means one that specializes in borreliosis testing. In the past, I have done head to head comparisons with 3 different regular labs. Western blots were drawn and sent on the same day to 2 different labs. The labs that specialize in borreliosis testing typically found borrelia-associated antibodies, that the regular laboratories missed. If these specialty labs find a borrelia antibody, I trust it to be significant, because patients respond to antibiotics. **You get what you pay for, so use a lab that specializes in borreliosis. The right way to process the Western blot specimen means for the blood to be drawn and express mailed early in the week. Research shows the borrelia antibodies have the potential to clump together, resulting in false negative test results. So far, unclumping has not been practical for laboratories to do. The fresher the specimen, the more accurate the test results. Patients at our office are scheduled Monday, Tuesday, or Wednesday if testing is to be done. This way, express shipping will assure that the specimen does not spend the weekend sitting at the post office. This is the right way to test and ship borreliosis specimens. Western blots look for antibodies. These antibodies are made by your immune system. In this case, the antibodies are made to fight against different parts of the Lyme bacteria, which is called Borrelia burgdorferi, and other Borrelia species. In other words, your immune system does not make one big antibody against the whole bacteria. So, when you see a number on a borreliosis Western blot, it corresponds to a specific part of the bacteria. Compare it to the old story of different blind people touching an elephant. Based on the part of the elephant each one touched, each person had their own perception. Likewise, the antibodies attach to different and specific parts of Borrelia burgdorferi. Numbers on Western blots correspond to weights. Kilodaltons (kDa) are the units used for these microscopic weights. Think of it like pounds or ounces. An 18 kDa antibody weighs 18 kilodaltons. To do a Western blot, thin gel strips are impregnated with the various parts of Borrelia burgdorferi. Each of the numbers, 18 through 93, on the test result form, is a part of the bacteria. Blood is made up of red blood cells and serum; Spinning blood in a centrifuge separates serum from red blood cells and other things, like white blood cells and platelets. Serum contains antibodies made by the immune system. Electricity is used to push the serum through the thin gel strips for the Western blot. If there are any antibodies against parts of Borrelia burgdorferi present in your serum, and these parts are impregnated on the strip, the antibody will complex (bind) to that part. When antibodies form a complex, it is called an antigen-antibody complex. Anything foreign in the body is an antigen, such as a ragweed pollen particle, germ, cancer, and even a splinter. In the case of borreliosis, the various parts of Borrelia burgdorferi are all antigens. Though each antigen is different, they all come from the same bacteria. So all the numbers that are positive on the test report are due to antigen-antibody complexes. If enough of the complexes are formed, eventually it may be seen with the naked eye as a dark band. - Band intensity reflects how dark or wide it is. Controversy exists about band intensity. Many would say the " +/-" equivocal bands are not significant. The problem I have with that, is that there are "-" negative bands. The lab has no trouble calling some bands negative. So they must be seeing something when they put "+/-" at some bands. The only thing that makes sense, is that there is a little bit of that antibody present in your serum. If the "+/-" equivocal is reported on the borrelia associated bands, it is usually significant, in my clinical experience. This is a strong clue that I am on the right track. Instead of ignoring these, they should be a red flag to keep pursuing a laboratory diagnosis. Giving patients 4 weeks of antibiotics (usually tetracycline, 500 mg, 3 times a day), will convert a negative or equivocal Western blot to positive in about 36% of cases. As mentioned, if these positive blots are found by specialty labs, over 99% of those patients will respond to antibiotics. Sometimes multiple antibiotics have to be tried before the patient feels better. Antibiotics may actually help with the laboratory diagnosis. But patients need to be off antibiotics about 10 to 14 days before the Western blot is repeated. This sounds like a contradiction. Antibiotics may help convert the test to positive, but patients need to be off antibiotics when the specimen is drawn. It is well documented in medical literature that the presence of antibiotics may cause false negative borreliosis testing. Therefore, your system should be free of all antibiotics for an accurate blot result. When the Lyme borrelia are alive, they are geniuses at avoiding the immune system. They may do things like go inside your white blood cells, and come out enclosed by the cell membrane of your own white blood cells! This may partly explain why antibodies against Borrelia burgdorferi are often not found when patients are tested. What may happen when patients are given 4 weeks of tetracycline (or other antibiotics) is that some of the bacteria die. When Borrelia burgdorferi dies, it is less efficient at avoiding the immune system. That's when antibodies may be formed against Borrelia burgdorferi, converting the negative or equivocal Western blot to positive, in about 36% of cases. If a borreliosis Western blot is going to be positive, it is usually the first one that is positive. The second blot is the next most likely to be positive, and so on, until the fifth blot. After that, the curve levels off for conversion to positive. This is based on research I presented in Bologna, Italy in 1994. Some patients had borrelia-associated antibodies finally show on their tenth Western blot! Two Western blots from a reliable lab usually gives the answer. If a third test is needed, a Lyme Urine Antigen Test (LUAT) is done instead of a third Western blot. Positive LUATs correspond very highly to patients getting better with antibiotics. False positive LUATs have not been a problem in my practice. The LUAT finds the actual antigen (Borrelia burgdorferi itself), so arguably it should be the test of choice, but the Western blot is rn6re widely accepted, even though it looks for the antibodies against Borrelia burgdorferi. The presence of antibodies are indirect evidence of an infection, not direct evidence like shown in the LUAT. On the Western blot test result form, please note what is "considered positive" and "considered equivocal." Equivocal is another way of saying suspicious or almost positive. Below this are the ASTPHLD/CDC recommendations. The CDC stands for the Center for Disease Control. I have been in attendance at the international borreliosis conferences when the CDC said their recommendations are for disease surveillance, not day-to-day clinical medical practice. I am not in the business of disease surveillance. My job is to try to help sick people. The CDC recommendations do not include the 31 and 34 Kda bands of the blot test. These two bands correspond to outer surface proteins A and B respectively (ospA and ospB). In the world of borreliosis, these are two of the classic hallmark Lyme antibodies. But the CDC does not even have them in their recommendations. You may see why I and other borreliosis clinicians do not agree with using the CDC criteria in everyday medical practice. Other bacteria besides Borrelia burgdorferi may produce the 45, 58, 66, and 73 kDa bands. These bands may be produced by Borrelia burgdorferi, but are not nearly as specifically associated with Lyme borreliosis as the starred bands. These starred bands are classic hallmark borrelia-associated antigen-antibody complexes. **An example of the CDC's criteria of a blot test, is if a patient has the band pattern of 41, 45, 58, 66, and 93, the CDC would call it positive. But if a patient has a 23-25, 31, 34, and 39 band pattern, they would call it negative. This is despite the fact that this second pattern of antigen-antibody complex bands is much more specifically associated with Borrelia burgdorferi than the first pattern. As you can see, borreliosis is very controversial. It would be alarming if I was the only clinician who thought that the CDC recommendations should not be used for day-to day medical practice. Many borrelia clinicians do not use the CDC criteria. This is obvious by the fact that the IgX laboratory uses different criteria for positive. Again, in my opinion and others', even one borrelia-associated antibody is significant, if symptoms exist. The classic triad of symptoms for borreliosis is fatigue (tiredness, exhaustion), musculoskeletal pain (joints, muscles, back, neck, headache), and cognitive problems (memory loss, trouble concentrating, difficulty remembering what you read, depression, disorientation, getting lost). But there are about 100 symptoms on the borreliosis questionnaire I use. Borreliosis may mimic or imitate virtually any disease. Patients often tell me that other physicians they have seen use the CDC recommendations. This is unfortunate, in my opinion, since these physicians are not in the business of disease surveillance, like the CDC is. But I am biased. After seeing patients with borreliosis since 1988, attending many conferences, talking with experts, and doing research on borreliosis testing, there is absolutely no question in my mind that physicians need to not blindly accept any recommendations. One of my hopes is that doctors will someday realize that this controversy is a signal for them to search for the truth. Why is there such conflict in this very "political" disease if there is not substance for disagreement? Both IgG and IgM Western blots should be done for borreliosis. With most infections, your immune system first forms IgM antibodies, then in about 2 to 4 weeks, you see IgG antibodies. In some infections, IgG antibodies may be detectable for years. Because Borrelia burgdorferi is a chronic persistent infection that may last for decades, you would think patients with chronic symptoms would have positive IgG Western blots. But actually, more IgM blots are positive in chronic borreliosis than IgG. Every time Borrelia burgdorferi reproduces itself, it may stimulate the immune system to form new IgM antibodies. Some patients have both IgG and IgM blots positive. But if either the IgG or IgM blot is positive, overall it is a positive result. Response to antibiotics is the same if either is positive, or both. Some antibodies against the borrelia are given more significance if they are IgG versus IgM, or vice versa. Since this is a chronic persistent infection, this does not make a lot of sense to me. A newly formed Borrelia burgdorferi should have the same antigen parts as the previous bacteria that produced it. But anyway, from my clinical experience, these borrelia associated bands usually predict a clinical change in symptoms with antibiotics, regardless of whether they are IgG or IgM. In regard to the outer surface proteins, think of it like the skin of a human. On the outer surface of the Lyme bacteria are various proteins. As they have been discovered, they have been assigned letters, such as outer surface proteins A, B, and C. The following is a brief explanation of the test results. Again, each band is an antigen complexed (bound together) with an antibody made by the immune system, specifically for that antigen (part) of Borrelia burgdorferi. 18: An outer surface protein. 22: Possibly a variant of outer surface protein C. 23-25: Outer surface protein C (osp C). 28: An outer surface protein. 30: Possibly a variant of outer surface protein A. 31: Outer surface protein A (osp A). 34: Outer surface protein B (osp B). 37: Unknown, but it is in the medical literature that it is a borrelia-associated antibody. Other labs consider it significant. 39: Unknown what this antigen is, but based on research at the National Institute of Health (NIH), other Borrelia (such as Borrelia recurrentis that causes relapsing fever), do not even have the genetics to code for the 39 kDa antigen, much less produce it. It is the most specific antibody for borreliosis of all. 41: Flagella or tail. This is how Borrelia burgdorferi moves around, by moving the flagella. Many bacteria have flagella. This is the most common borreliosis antibody. 45: Heat shock protein. This helps the bacteria survive fever. The only bacteria in the world that does not have heat shock proteins is Treponema pallidum, the cause of syphilis. 58: Heat shock protein. 66: Heat shock protein. This is the second most common borrelia antibody. 73: Heat shock protein. 83: This is the DNA or genetic material of Borrelia burgdorferi. It is the same thing as the 93, based upon the medical literature. But laboratories vary in assigning significance to the 83 versus the 93. 93: The DNA or genetic material of Borrelia burgdorferi. In my clinical experience, if a patient has symptoms suspicious for borreliosis, and has one or more of the following bands, there is a very high probability the patient has borreliosis. These bands are 18, 22, 23-25, 28, 30, 31, 34, 37, 39, 41, 83, and 93. This is true regardless of whether it is IgG or IgM.. But again, there is (no universal agreement) on the significance of these bands. Betina Wilska, M.D. from Germany is one of the world's experts on outer surface protein A (31 kDa). At the international borreliosis conference in Vancouver, British Columbia, I asked her personally about the 30 kDa band. She told me it was the same as the 31 kDa band (osp A). When you have the opportunity to talk to borreliosis experts, this helps in assigning significance to findings, on an imperfect test. As a medical doctor, I am stating all of this with no axe to grind, no professorship to protect, and no preset opinions. Patients, personal research, and conferences have helped me interpret the borreliosis medical literature in regard to testing. Nobody would like to have available a bullet-proof, 100% reliable Lyme borreliosis test more than I would. But we must use what is currently available. I always welcome second opinions. Dr. C in Missouri
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ And The Bands Played On - Western blot serological test for Lyme disease http://www.geocities.com/HotSprings/Oasis/6455/western-blot.txt ************************************************************************ as of 1 March 2001 Table of Contents Terminology. Borrelia burgdorferi bands mentioned in medical literature (MEDLINE). Named bands - the gene names. Bands specific for Borrelia burgdorferi. Cross-reacting bands. Bands found, or tested for, in IgM analysis in USA or Mexico. Bands found, or tested for, in IgG analysis in USA or Mexico. Other bands found in IgM/IgG in other countries. The "CDC recommended" bands for Western blot testing - CDC/MMWR 1995. For more information about the Western blot test and Lyme disease. ----- Terminology: Bb Borrelia burgdorferi (the Lyme disease bacteria) Bdr Borrelia direct repeat Bmp Bacterial membrane protein Dbp decorin binding protein Fla flagellin Fn-B fibronectin-binding protein GroEL a chaperonin 60 heat-shock protein isolated from Escherichia coli Hsp heat shock protein HSP Heat Stress Protein kDa kilodaltons (a measurement of size) Mab monoclonal antibodies MgtE magnesium transporter protein Oms outer membrane-spanning Osp outer surface protein P protein p protein PBP penicillin-binding protein PMID PubMed ID (identification system for citations) Tbp transferrin-binding protein Other terms might be found at: The Jounrnal of Clinical Investigation - Abbreviations http://www.jci.org/misc/abbreviations.shtml ----- Borrelia burgdorferi bands mentioned in medical literature (MEDLINE): Note: Bands preceded with an asterisk are the 11 Western blot bands for the ASTPHLD, CDC, FDA, NIH, CSTE, NCCLS 1994 conference recommendation ("CDC recommendation") for the serologic diagnosis of Lyme disease - see 1995 CDC MMWR link below. 5-kDa 7.5-kDa 11-kDa 13-kDa surface protein - sensu stricto, afzelii 14-kDa internal flagellin fragment [specific for Bb] 15 kDa polypeptide [also for syphilis] 16-kDa 17-kDa Osp 17 [B. afzelii] *18-kDa p18 flagellin fragment 19-kDa immunogenic integral membrane lipoproteins cross-reactive with other spirochetes/bacteria Characterization of antigenic determinants of Bb shared by other bacteria. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=1372635&form=6&db=m&Dopt=b 19-kDa decorin-binding protein 20-kDa decorin-binding protein 20.5-kDa 20.7-kDa *21-kDa OspC [specific for Bb] 22-kDa [specific for Bb or cross-reactive depending on what one reads] immunogenic integral membrane lipoproteins [cross-reactive with other spirochetes/bacteria] Characterization of antigenic determinants of Bb shared by other bacteria. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=1372635&form=6&db=m&Dopt=b 22-kDa OspC [specific for Bb] 22-25kDa OspC 23-kDa OspC *24-kDa OspC 25-kDa OspC [specific for Bb] 26-kDa 27-kDa Osp, Hsp (Europe burgdorferi strain B29, but not American strain B31) *28-kDa OspD, Oms28 [specific for Bb] 29-kDa OspA? 30-32-kDa OspA *30-kDa OspA substrate binding protein 31-kDa OspA [specific for Bb] 32-kDa OspA 33-kDa outer membrane 34-kDa OspB [specific for Bb] 34-36-kDa OspB 35-kDa OspB [specific for Bb] 35.5-kDa 36-37-kDa 37-kDa P37, FlaA gene product, [specific for Bb] 38.0-kDa FlaA *39-kDa BmpA [specific for Bb] 40-kDa *41-kDa FlaB 42-kDa 43-kDa 44-kDa *45-kDa [appeared in IgM in control group in 1998 study done in Poland] MEDLINE - 9972057 - "...whereas in control group only antibodies against 45 kDa and 58 kDa were present." http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9972057&form=6&db=m&Dopt=b [appears for HGE] MEDLINE - 9620365 - "...confirmed the importance of the 42- to 45-kDa antigens as early, persistent, and specific markers of HGE infection." http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9620365&form=6&db=m&Dopt=b 46-kDa 47-kDa P47 fibronectin-binding protein [specific for Bb] 48-kDa 49-kDa 50-kDa [specific for Bb] 51 kDa MgtE 52-kDa Fn-BA 54-kDa [other Borrelia] 55-kDa 56-kDa 57-kDa PBP *58-kDa (not GroEL) 59-kDa [a genetically engineeried fragment of the 83-kDa protein] 60-kDa Hsp [all Borrelia] 62-kDa Hsp60 63.7-kDa 64-kDa (P64) [cross-reacts to human axonal proteins] 65-kDa *66-kDa P66 Oms66 Hsp outer/integral membrane protein 67-kDa 68-kDa 70-kDa Hsp 71-kDa 72-kDa Hsp [cross-reactive with other spirochetes] [cross-reactive with other spirochetes/bacteria] Characterization of antigenic determinants of Bb shared by other bacteria. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=1372635&form=6&db=m&Dopt=b 73-kDa 75-kDa 77-kDa a genetically engineered recombinant hybred Use of a hybrid protein consisting of the variable region of the Borrelia burgdorferi flagellin and part of the 83-kDa protein as antigen for serodiagnosis of Lyme disease. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8027303&form=6&db=m&Dopt=b 78-kDa OspA 79.8-kDa 80-kDa 83-kDa p83 high molecular mass protein [specific for Bb] 84-kDa [B. garinii] 88-kDa 92-kDa *93-kDa an immunodominant protoplasmic cylinder antigen, associated with the flagellum [specific for Bb] 94-kDa PBP [specific for Bb] 95-kDa 97-kDa associated with flagella 100-kDa P100 110-kDa 200-kDa a fusion protein, a hybrid protein ----- Named bands - the gene names: BmpA, BmpB, BmpC "the 39 kDa Bmp protein family", PMID: 8978084 BmpD, PMID: 8606088 FlaA, an outer sheath protein of the periplasmic flagella 37-kDa, PMID: 9986810 38-kDa, PMID: 9573194, PMID: 8990312 FlaB, 41-kDa PMID: 9573194 FlgE, protein 40-kDa?, PMID: 8548542 ospAB,28-34-kDa, PMID: 9596714 --- OspA = 29-33.5 kDa Regarding OspA AND Lyme disease the following molecular weights are associated with OspA in the MEDLINE database: Note: To see the abstract for a particular PMID number, simply insert the number, via copy and paste, in the following URL after the "&list_uids=" term: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=&d opt=Abstract Example, using the first number below: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list _uids=10638032&dopt=Abstract 29-31 kDa - PMID: 10638032, 8429231 29.6 kDa - PMID: 1406458 30 kDa - PMID: 7500914 30-32 kDa - PMID: 2461135 31-kDa - PMID: 10030131, PMID: 8005219, PMID: 8406878, PMID: 1520966 PMID: 1554741, PMID: 10699329, PMID: 8825913 32-kDa - PMID: 8005219, PMID: 1520966 32-kDa/rOspA dog vaccine - PMID: 8567917 32.5 kDa - PMID: 9144917, PMID: 8004045 33 kDa - PMID: 1520966, PMID: 8005219 33.5 kDa - PMID: 8004045, PMID: 1520966 --- OspB 34-kDa PMID: 10030131 OspC 21-25-kDa, 22-25-kDa - PMID: 8825913, OspD 28-kDa, PMID: 8825913 OspE 19.2-kDa [calculated], PMID: 8262642 OspF 26.1-kDa [calculated], PMID: 8262642 ----- Bands specific for Borrelia burgdorferi: 14-kDa ? 21-kDa 22-kDa OspC 25-kDa OspC 28-kDa OspD 31-kDa OspA 34-kDa OspB 35-kDa 37-kDa 39-kDa 47-kDa 50-kDa 83-kDa 93-kDa 94-kDa Notes: 14-kDa ? PMID: 9920119, PMID: 1556546 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9920119&form=6&db=m&Dopt=bhttp://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=1556546&form=6&db=m&Dopt=b B. burgdorferi: 22 kDa, 31 kDa, 34 kDa, 39 kDa, 83 kDa - PMID: 9440203 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9440203&form=6&db=m&Dopt=b p35 and p37 are Borrelia burgdorferi genes - PMID: 9175831 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9175831&form=6&db=m&Dopt=b at least one is an apparently specific band (25, 28, 39, 47, 50, or 93 kDa). - PMID: 7791177 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=7791177&form=6&db=m&Dopt=b antibodies against the 94 kDa, 31 kDa and 21 kDa proteins are largely species-specific. - PMID: 8223404 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8223404&form=6&db=m&Dopt=b ----- Cross-reacting bands: 19-kDa 22-kDa ?? 20-kDa 30-kDa 33-kDa 34-kDa ?? 36-kDa 40-kDa 41-kDa 60-kDa 66-kDa 72-kDa Notes: Search terms: cross-react* cross-antigenicity crossreact Immunoblot analysis indicated the presence of cross-reacting antibodies directed to B. burgdorferi antigens with apparent molecular weights of 60, 41, 40, 36, 30 and 20 kDa. - PMID: 1385332 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=&form=6&db=m&Dopt=b P66, P60, P41 which are dominant immunogens of all types of borrelias PMID: 9162453 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9162453&form=6&db=m&Dopt=b 19, 22[??], 72 - PMID: 1372635 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=1372635&form=6&db=m&Dopt=b 60-75 kDa range, p40, p33 and two proteins in the range of 20 kDa. - PMID: 1597198 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=1597198&form=6&db=m&Dopt=b Whereas the 60 kDa, 41 kDa, and 34 kDa[??] constituents reveal a marked cross-antigenicity with other spirochetes and even more distantly related bacteria,...PMID: 8223404 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8223404&form=6&db=m&Dopt=b ----- Bands found, or tested for, in IgM analysis in USA or Mexico. 18-kDa 21-kDa 23-kDa 24-kDa 25-kDa 28-kDa 37-kDa 39-kDa 41-kDa 45-kDa 55-kDa 58-kDa 60-kDa 66-kDa 93-kDa Notes: 37 - PMID: 9986810 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9986810&form=6&db=m&Dopt=b 41 kDa and 58 kDa - PMID: 9972057 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9972057&form=6&db=m&Dopt=b 24 kDa (OspC), 41 kDa, and 37 kDa - PMID: 8748261 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8748261&form=6&db=m&Dopt=b 39, 58, 60, 66, or 93 kDa - PMID: 8748261 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8748261&form=6&db=m&Dopt=b 55-kDa - PMID: 7642278 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=7642278&form=6&db=m&Dopt=b Recommended criteria for the immunoglobulin M (IgM) immunoblot are the recognition of two of three proteins (24, 39, and 41 kDa). PMID: 7714202 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=7714202&form=6&db=m&Dopt=b 25-kDa antigens - PMID: 8308100 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8308100&form=6&db=m&Dopt=b 23-kDa - PMID: 8225587 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8225587&form=6&db=m&Dopt=b at least 2 of the 8 most common IgM bands in early disease (18, 21, 28, 37, 41, 45, 58, and 93 kDa) - PMID: 8380611 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8380611&form=6&db=m&Dopt=b ----- Bands found, or tested for, in IgG analysis in USA or Mexico. 18-kDa 20-kDa 21-kDa 22-kDa 23-kDa 24-kDa 28-kDa 29-kDa 30-kDa 31-kDa 34-kDa 35-kDa 39-kDa 41-kDa 45-kDa 55-kDa 58-kDa 88-kDa 62-kDa 66-kDa 93-kDa Notes: A serum sample was considered positive by WB [IgG] if at least three of the following protein bands were recognized: 18, 24, 28, 29, 31, 34, 39, 41, 45, 58, 62, 66, and 93 kDa. PMID: 10071428 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10071428&form=6&db=m&Dopt=b 93, 39, 34 or 23 kDa IgG bands - PMID: 9580180 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9580180&form=6&db=m&Dopt=b 55-kDa - PMID: 7642278 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=7642278&form=6&db=m&Dopt=b The recommended criteria for a positive IgG immunoblot are the recognition of two of five proteins (20, 24 [> 19 intensity units], 35, 39, and 88 kDa). Alternatively, if band intensity cannot be measured, the 22-kDa protein can be substituted for the 24-kDa protein with only a small decrease in sensitivity. PMID: 7714202 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=7714202&form=6&db=m&Dopt=b at least 5 of the 10 most frequent IgG bands after the first weeks of infection (18, 21, 28, 30, 39, 41, 45, 58, 66, and 93 kDa)-PMID: 8380611 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8380611&form=6&db=m&Dopt=b 66 kDa and 31/34 kDa - PMID: 3819479 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=3819479&form=6&db=m&Dopt=b ----- Other bands found in IgM/IgG in other countries: Europe/Germany - PMID: 9163458 The following interpretation criteria resulting in specificities of greater than 96% were recommended: for IgG WB, at least one band of p83/100, p58, p56, OspC, p21, and p17a for PKa2; at least two bands of p83/100, p58, p43, p39, p30, OspC, p21, p17, and p14 for PKo; and at least one band of p83/100, p39, OspC, p21, and p17b for PBi; for IgM WB, at least one band of p39, OspC, and p17a or a strong p41 band for PKa2; at least one band of p39, OspC, and p17 or a strong p41 band for PKo; and at least one band of p39 and OspC or a strong p41 band for PBi. IgG titers to P35 and P37 Mice/Northern blot - PMID: 9175831 Italy - PMID: 8809552 The overall reactivity of the three Borrelia strains in IgG immunoblots indicated that ten protein bands were significant, with a different prevalence of some of them in the two groups of patient sera: bands at 60-58, 30-33, 36-37 and 28-27 kDa were markers for neuroborreliosis sera; proteins at 100-83, 72-70 and 18-17 kDa behaved like markers for Lyme arthritis. The IgM Immunoblots revealed significant bands at 100-83, 72-70, 51, 24- 21 and 18-17 kDa only with neuroborreliosis sera. Russia - PMID: 7791165 IgG reactivity with > or = 5 spirochetal proteins, particularly the 37, 39, 41, 60, and 93 kDa antigens Germany - PMID: 8167425 IgG - 95 and 19-17 kDa France - PMID: 8405312 [IgG] Reactions with specific protein bands (94, 73, 30 and 21 KDa) ----- The "CDC recommended" bands for Western blot testing - CDC/MMWR 1995. The ASTPHLD, CDC, FDA, NIH, CSTE, NCCLS 1994 conference recommendation ("CDC recommendation") for the serologic diagnosis of Lyme disease - CDC/MMWR 1995: ASTPHLD - Association of State and Territorial Public Health Laboratory Directors CDC - Centers for Disease Control and Prevention FDA - Food and Drug Administration NIH - National Institutes of Health CSTE - Council of State and Territorial Epidemiologists NCCLS - National Committee for Clinical Laboratory Standards According to CDC's Morbidity and Mortality Weekly Report (MMWR) 1995; 44 (31):590-591, an IgM immunoblot is considered positive if two of the following three bands are present: 24 kDa (OspC)* 39 kDa (BmpA) 41 kDa (Fla) An IgG immunoblot is considered positive if five of the following 10 bands are present: 18 kDa 21 kDa (OspC)* 28 kDa 30 kDa 39 kDa (BmpA) 41 kDa (Fla) 45 kDa 58 kDa (not GroEL) 66 kDa 93 kDa * The apparent molecular mass of OspC is dependent on the strain of B. burgdorferi being tested. The 24 kDa and 21 kDa proteins referred to are the same. Recommendations for Test Performance and Interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease, CDC MMWR, August 11, 1995 / 44(31);590-591 http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00038469.htm or http://wonder.cdc.gov/wonder/prevguid/m0038469/entire.htm ----- For more information about the Western blot test and Lyme disease, see: The National Lyme Disease Network LymeNet Newsletter Volume 4 - Number 13 - 9/23/96 SPECIAL ISSUE - Understanding the Western Blot http://www2.lymenet.org/domino/nl.nsf/UID/4-13 Explanation of the Lyme Disease Western Blot by Carl Brenner http://www.lymealliance.org/Medical/MedCategory4/Lab4/lab4.html Laboratory Tests by Tom Grier - Part 2 - Western Blot and ELISA http://www.lymealliance.org/Medical/MedCategory4/Med12A/med12a.html IGeneX, Inc. - Lyme Disease Western Blot http://www.igenex.com/lymeset2.htm MRL Diagnostics' Lyme Disease B. burgdorferi Genogroup 1 Western Blot IgG test http://www.mrldiagnostics.com/insert/wb0400g.htm Immuno-Biological Laboratories (IBL) - Hamburg [Germany] - Borrelia burgdorferi/Lyme IgG Western Blot http://www.ibl-hamburg.com/prod/re_97228.htm The western immunoblot for Lyme disease: determination of sensitivity, specificity, and interpretive criteria with use of commercially available performance panels. Tilton RC, Sand MN, Manak M BBI Clinical Laboratories, Inc., New Britain, Connecticut 06053, USA. Clin Infect Dis 1997 Jul;25 Suppl 1:S31-S34 http://www.x-l.net/Lyme/BBI_TEST.htm SIMULTANEOUS ELISA AND WESTERN BLOT TESTING IN EVALUATION OF PATIENTS FOR SUSPECTED LYME DISEASE Janice M. Kochevar, FNP-C, Kenneth B. Liegner, M.D. LDF 10th Annual International Scientific Conference on Lyme Borreliosis & Other Tick-borne Disorders: April 28-30, 1997 http://www.x-l.net/Lyme/elisawb497.htm MEDLINE - Western Immunoblot*/blot* [in Title] AND Lyme Disease - 33 on 1 Mar 2001 [URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=PubMed&orig_db=PubMed&dispmax=1000&doptcmdl=DocSum&term=%28western%5BTI%5D+AND+%28immunoblot*%5BTI%5D+OR+blot*%5BTI %5D%2]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=PubMed&orig_db=PubMed&dispmax=1000&doptcmdl=DocSum&term=%28western%5BTI%5D+AND+%28immunoblot*%5BTI%5D+OR+blot*%5BT I%5D%2[/URL] 9+AND+%28lyme+OR+burgdorferi+OR+%28borreli*+AND+ixodes%29+OR+%28%28erythema+AND+migrans%29+NOT+glossitis%29+OR+garinii+OR+afzelii+OR+neuroborreli*%29 ----- For more information on Lyme disease, see: Lots Of Links On Lyme Disease http://www.geocities.com/HotSprings/Oasis/6455/lyme-links.html
-------------------- Do unto others as you would have them do unto you. Remember Iam not a Doctor Just someone struggling like you with Tick Borne Diseases.
posted
Oh wow Tracy-----take him to a llmd, sooner than later. A quest or labcorp test is an extreme cruelty perpetrated on unsuspecting victims and can be ruiners of lives. Get him to a good doc who will run extensive and good tests!
Posts: 554 | From Naples, Italy | Registered: Jun 2006
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CaliforniaLyme
Frequent Contributor (5K+ posts)
Member # 7136
posted
From the Master himself- ************************ 1: J Infect Dis. 1993 Feb;167(2):392-400.Links Comment in: J Infect Dis. 1993 Oct;168(4):1073.
Western blotting in the serodiagnosis of Lyme disease.
Dressler F, Whalen JA, Reinhardt BN, Steere AC. Division of Rheumatology/Immunology, Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts 02111.
There are currently no accepted criteria for positive Western blots in Lyme disease. In a retrospective analysis of 225 case and control subjects, the best discriminatory ability of test criteria was obtained by requiring at least 2 of the 8 most common IgM bands in early disease (18, 21,
28,
37, 41, 45, 58, and 93 kDa) and by requiring at least 5 of the 10 most frequent IgG bands after the first weeks of infection (18, 21,
28,
30, 39, 41, 45, 58, 66, and 93 kDa). When these definitions were tested in a prospective study of all 237 patients seen in a diagnostic Lyme disease clinic during a 1-year period and in 74 patients with erythema migrans or summer flu-like illnesses, the IgM blot in early disease had a sensitivity of 32% and a specificity of 100%; the IgG blot after the first weeks of infection had a sensitivity of 83% and a specificity of 95%. Among patients with indeterminate IgG responses by ELISA, 6 of 9 patients with active Lyme disease had positive blots compared with 2 of 34 patients with other illnesses. Thus, Western blotting can be used to increase the specificity of serologic testing in Lyme disease.
PMID: 8380611
-------------------- There is no wealth but life. -John Ruskin
All truth goes through 3 stages: first it is ridiculed: then it is violently opposed: finally it is accepted as self evident. - Schopenhauer Posts: 5639 | From Aptos CA USA | Registered: Apr 2005
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timaca
Frequent Contributor (1K+ posts)
Member # 6911
posted
Tracy~
If bloodwork has revealed that he had mono in the past then I would get him tested for viruses. Go to www.hhv-6foundation.org. Read the testing link there and also read on the patient's link. There is lots of good info there on how to go about getting him tested.
Dr. Montoya at Stanford is treating people who are ill (like your son is), who had "mono" or some other flu like illness and never got totally well. He is getting some of these people well using Valcyte.
Now, since he also had a problem with antibiotics, lyme may be an issue. However his first WB is pretty unremarkable. You can rule this out further by running other WB tests at Stonybrook, Igenex and MDL.
There is no way to tell by symptoms whether or not someone has a lyme or viral infection. And they could have both (seems I do).
Research the viral end of things while you also pursue more lyme testing.
Timaca
Posts: 2872 | From above 7,000 ft in a pine forest | Registered: Feb 2005
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